The knee joint is formed from three bones, the femur (thighbone), the tibia (shinbone) and the patella (knee cap). Also and referring now to FIG. 1, there are two wedge-shaped pieces of cartilage that are positioned between the femur and tibia, which act as shock absorbers. These pieces of cartilage are called the meniscus and are tough and rubbery to help cushion the knee joint and keep it stable.
Meniscal tears are amongst the most common injuries to the knee. Sports-related meniscal tears also often occur along with other injuries to the knee such as tears or damage to the anterior cruciate ligament. However, people can experience a non-sports related meniscal tear or undergo a degenerative meniscal tear. For example, the cartilage can weaken and wear thin over time and such aged, worn tissue is more prone to tearing. As a result an awkward twist by a person when getting up from a chair may be enough to cause a meniscal tear, if weakened by age.
Meniscal tears can be treated in a number of different ways including (a) a nonsurgical treatment regime and/or (b) a surgical treatment regime. The type of treatment plan depends upon a number of factors including the type of tear one has, its size and location. For example, a tear(s) in a certain region of the meniscus may not heal effectively and thus the damaged piece(s) of the meniscus may be surgically trimmed away using an arthroscopic technique. In addition to the type of tear, other factors to consider include the age of the person, their activity level and any other related injuries that would need to be factored into the person's treatment plan (e.g., tears or injuries to the ACL).
If nonsurgical treatment does not appear to be effective (e.g., symptoms persist) or it is determined from the outset that nonsurgical treatment is not a viable option, then the doctor may recommend surgical treatment of the affected knee using any of a number of techniques and devices that are known in the art. Typically, an arthroscopic surgical technique is utilized along with various surgical instruments that have been developed for use in the technique to trim and/or repair the damaged tissue.
There are a number of meniscal repair procedures available for treating such damaged tissue that are commonly referred to as “all inside” meniscal repair procedures. These procedures have been found to be relatively easy to use to repair meniscal tears found in the posterior and middle segments of the meniscus; although such procedures require the surgeon to steer around nerves and tissue such as the ACL and PCL so as to reach the targeted area. However, the related repair devices are generally not capable of reaching tears in areas of the anterior segment of the meniscus. Consequently repairs in the anterior segment can involve techniques that require a surgeon to access the anterior and posterior regions of the knee to fully access and repair tears in the anterior segment. Also, such procedures are more difficult and also increase the risk of injury to surrounding tissue, muscle and nerves by the surgical devices.
There are a number of devices and techniques known in the art that have been developed for the surgical treatment of meniscal tears. A number of these techniques and related devices involve piercing the meniscus at one or more locations proximal to a tear with a needle carrying one or more anchors or implants that are coupled to a suture, deploying the anchor or implant at a back surface or side of the meniscus, withdrawing the deployment device and repeating the process to deploy any other anchors/implants. After all of the anchors/implants are deployed the surgeon using the appropriate technique, tightens the suture so as to draw the pieces comprising the tear together so they can heal over time.
The anchor or implant is typically made from a material that will eventually be absorbed over time or not absorbed overtime (e.g., PEEK). There are some techniques, however, in which a portion of a suture is used to form an anchor or implant (e.g., using a ZipLoop manufacturing technique). In this all suture technique, the deployment device is operated so that the portion of the suture forming the anchor/implant is deployed on the back side of the meniscus.
In these techniques, the anchor/implant deployment device usually embodies a sheath or cannula that is disposed about a needle member that carries the anchors/implants. The sheath or cannula is used to protect the person from inadvertent injury that could be caused by the needle member coming into contact with the surrounding tissue and the like, as well as to protect the anchor/implant and related sutures from coming into contact with the tissue and the like during insertion which could cause an inadvertent deployment. In use, the needle member is positioned in proximity to a targeted site of the meniscus so that the needle can be caused to pass through the meniscus and so that an anchor/implant can be appropriately deployed from the needle member.
The cannula and/or the needle member are typically arranged to have any one of a number of fixed geometries including a straight or a curved geometry. In use, the surgeon selects the geometry that is believed to best suited for reaching the targeted site without causing further injury to the patient, from the portal or entry site made in the skin and tissue proximal the knee joint such as when using an arthroscopic technique. In one technique the cannula is malleable so that the surgeon can bend the cannula in a desired manner.
There is another technique that uses a deployment device having two needle members that are arranged so that both pierce the meniscus at the targeted site. A suture is then deployed from the ends of two needle members proximal the back side of the meniscus. After withdrawing the needle members from the meniscus, the suture is arranged so that it extends along the back side of the meniscus and through the meniscus. The surgeon using the appropriate technique, tensions the suture to draw the tear together and to secure the suture in place.
After tightening the suture using any of the above described suture based techniques, the surgeon takes the appropriate actions to cut off the excess length of the suture. In exemplary embodiments, the surgeon typically inserts a suture cutter into the knee joint or capsule and advances the suture cutter along the suture to a particular point where the surgeon actuates a device (e.g., suture cutter) to cut off the excess length of suture.
There is found in U.S. Publication No. 2003/0139754 (which corresponds to U.S. Pat. No. 8,409,250), a system and surgical methods for repairing tears in meniscal tissue using meniscal darts. The system includes a cannulated insertion sheath, a meniscal dart, and a disposable dart driver preloaded with the meniscal dart at its distal end. According to the methodology, the insertion sheath is inserted into the meniscus such that a tip of the sheath is located near a meniscal tear. The dart driver with a preloaded dart is advanced through the insertion sheath such that the preloaded meniscal dart at the driver's distal end is inserted through the meniscal tear and so it remains disposed within the meniscus. The meniscal dart is used alone and without a suture to fix the meniscal tear.
There is found in U.S. Publication No. 2012/0239086, a suture anchor and delivery system, a method for attaching sutures to body tissue, a suture anchor for use in non-linear, non-collinear or divergent angle deployment and a control rod for a suture anchor and delivery assembly. The phrase non-linear, non-collinear or divergent angle deployment is understood to mean or describe a method and device where the suture anchor is deployed at an angle with respect to the long axis of the insertion device, guide or insertion cannula. This means that the long axis of the insertion device or cannula is not configured and arranged so the long axis is generally pointing in the direction of the targeted area. The suture anchor is designed with a curved body and beveled tip to facilitate its engagement with a tunnel (or hole) that is formed in a bone or cartilage support surface. The suture anchor is used in combination with an insertion device, guide or insertion cannula and a control rod so that the suture anchor can be inserted into the tunnel.
There is found in U.S. Publication No. US2004/0162559 (which corresponds to U.S. Pat. No. 6,875,219), instruments, systems and methodology for nonlinear access to bone tissue sites. More particularly, there is provided a bone access system offering radial access to sites with reduced user risk and ease of use. The system employs a flexible (semi-rigid) conduit that is formed into a curved shape by a curved core wire once the end of each item is advanced beyond the end of a cannula which restrains the core member (via the intermediately-located conduit). The core wire has a relatively low stiffness so it is easily set within the cannula (either together with the conduit or after the conduit has been placed therein). It is further provided that the conduit is for delivering material or a medical device to the site and that the core member is able to steer the conduit and allow the combination to be advanced thorough cancellous bone (cancellous bone is found in the interior of bones of the human skeleton).
There is found in U.S. Pat. No. 6,074,395, implant devices, instruments and methods for repairing body tissue during endoscopic surgical procedures such as those used when repairing meniscal tissue during arthroscopic surgery of the knee. As further described the instruments and methods are for inserting into a site of implantation, elongated devices having transversely extending barbs or projections which assist in retaining the implant in place within a tissue defect (e.g., a tear) and to hold body tissue in close approximation for healing or other reasons. Such elongated devices also are arranged so as to include a bore that extends lengthwise (longitudinal extending bore).
There is found in U.S. Publication No. 2008/0228204 (which corresponds to U.S. Pat. No. 8,257,371), medical suturing devices, systems, and methods that can be used in endoscopic (with or without access ports) or other surgeries in which access is limited, including open and minimally invasive surgical techniques. Articulation motions by the surgeon may be transferred from a handle to needle grasping jaws using an axial movement of a shaft that has axial stiffness (such as being stiff in compression) and lateral flexibility or an axial movement of a cable and such motions may be used to manipulate a needle so as to allow the surgeon to form stitches with the needle. Such a device can include an extension body (within which the shaft or cable moves) between the handle and jaws that can be pre-bent or custom bent by the user. Portions of the devices may be disposable, replaceable, and/or reusable. It also is provided that the device can include one or parts that can be disposable.
There is found in U.S. Publication No. 2013/0296989, an implanter 10 for nerve stimulation that includes a plurality of preformed stylets and a hollow needle. Also found is a method for introducing an implant for stimulating a nerve using the implanter. The implants may include electrical electrodes (leads), catheters, waveguides, laser and optical fibers, and mechanical, thermal, and chemical sensors, as well as medications, radiation seeds, viral vectors, chemicals, and other suitable materials. The hollow needle carrying the preformed stylet is inserted into a target region such as a subcutaneous region. Such a target region may be positioned within a brain or within a spine.
There is found in U.S. Publication No. 2012/0253116, a surgical system that includes a reusable handle assembly having a controller (e.g., a joystick controller); a reusable cannula assembly configured to be operatively connected to and steerable by the reusable handle assembly; and a plurality of surgical instruments. The surgical instruments are configured so as to be inserted through the reusable handle assembly and configured to advance a length of the reusable cannula assembly, and such that the plurality of surgical instruments are engaged with at least one trigger mechanism of the reusable handle assembly. Also, the handle assembly, the cannula assembly, and the plurality of surgical instruments are modular components configured to be releasably connected or coupled to each other.
It is further provided that a distal end of the reusable cannula assembly 120 includes a plurality of articulation linkages, which may be equally spaced apart from each other. The articulation linkages may be flexible segments, which are of equal length relative to each other or which are of different length relative to each other. The plurality of articulation linkages, distally disposed, facilitate the bending of a portion of the surgical instrument via the controller. Also, the reusable cannula assembly may include linkages that are not controlled by the controller which may define a pre-set bend actuated by operating switch.
There is found in U.S. Publication No. 2009/0138095 (which corresponds to U.S. Pat. No. 8,246,692), a method for treating a cartilage defect by implanting a cartilage replacement implant through an arthroscopic access. Such a method includes determining at least one parameter for describing the arthroscopic access, providing surgical instrumentation including at least two different applicator instruments for grasping the cartilage replacement implant, choosing one of the at least two applicator instruments of the instrumentation in dependence upon the at least one parameter determined for describing the arthroscopic access, and grasping and inserting the cartilage replacement implant into the patient's body with the chosen instrument through the arthroscopic access.
There is found in U.S. Publication No. 2012/0053641 (which corresponds to U.S. Pat. No. 8,801,716), methods for repairing cartilage in a patient as well as systems for repairing such cartilage. Such a system is for repairing, harvesting, and placement of cartilage (e.g., a cartilage plug including both cartilage and attached bone tissue). More specifically, the system (i.e., the trephine) can harvest the cartilage plug from a donor site and then using a guide tool and the ejector tool can be used to place the harvested plug at the defect site.
It thus would be desirable to provide a new deployment device that can deploy anchors/implants and which deployment device has the capability to adjust the end geometry of such a device and methods related thereto. It would be particularly desirable to provide such a device that would be capable of adjusting the end geometry and thus the path of the deployment device either when outside of the body and/or when in-situ or within the body. It also would be desirable to provide such a deployment device that would not increase the difficulty of using such a device or require an increase in the skill level of those using such devices.